Washington Death with Dignity Act

To comply with the Act and receive the immunity protection provided by it, physicians and pharmacists must make a good faith effort to file required documentation in a complete and timely manner. If the attending or consulting physician (or the psychiatrist or psychologist, if a referral is made) determines that a patient does not meet the qualifications to receive a prescription for medication under the Act, no forms have to be submitted.

Within 30 days of writing a prescription for medication under the Act, the attending physician must file the following forms with the Department:

A psychiatric or psychological evaluation is not required under the terms of the law. However, if the attending or consulting physician requests an evaluation, the psychiatrist or psychologist must complete a Psychiatric/Psychological Consultant Compliance Form and the attending physician must file this form within 30 days of writing the prescription.

Within 30 days of a qualified patient’s death from ingestion of a lethal dose of medication obtained under the Act or death from any cause, the attending physician must file an Attending Physician After Death Reporting Form. Under Washington law, a death certificate must be completed within 72 hours of death and filed with the local health agency where the death occurred.

Attending physicians must register on the Death with Dignity Attending Physicians Portal. The Portal allows physicians to attest to completing the Physicians Education Module; enroll patients in the Death with Dignity Program; correspond with consulting physicians, psychologist/psychotherapist, pharmacist and patients using email notifications; send, receive and upload forms; schedule appointments and follow-ups; and create tasks and notes.

WHAT IS PHYSICIAN-ASSISTED DEATH?

Physician-assisted dying generally refers to a practice in which the physician provides a terminally ill patient with a prescription for a life-ending dose of medication, upon the patient’s voluntary, informed request.

ISN’T PHYSICIAN-ASSISTED DEATH THE SAME AS EUTHANASIA?

No. Physician-assisted dying refers to the physician providing the means for death, most often with a prescription. The patient, not the physician, will ultimately administer the lethal medication. Euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient’s life. Some other practices that should be distinguished from Death with Dignity are:

Terminal sedation: This refers to the practice of sedating a terminally ill competent patient to the point of unconsciousness, then allowing the patient to die of her disease, starvation, or dehydration.

Withholding/withdrawing life-sustaining treatments: When a competent patient makes an informed decision to refuse life-sustaining treatment, there is virtual unanimity in state law and in the medical profession that this wish should be respected.

Pain medication that may hasten death: Often a terminally ill, suffering patient may require dosages of pain medication that impair respiration or have other effects that may hasten death. It is generally held by most professional societies, and supported in court decisions, that this is justifiable, as long as the primary intent is to relieve suffering.

IS PHYSICIAN-ASSISTED DEATH ETHICAL?

The ethics of assisted death continue to be debated. Some often argue that physician-assisted dying is ethical on the grounds that it may be a rational choice for a person who is choosing to die to escape unbearable suffering. Furthermore, the physician’s duty to alleviate suffering may, at times, justify the act of providing assistance with dying. These arguments rely a great deal on the notion of individual autonomy, recognizing the right of competent people to chose for themselves the course of their life, including how it will end.

Others have often argued that physician aid in dying is unethical because it runs directly counter to the traditional duty of the physician to preserve life. Furthermore, many argue if hastened death were legal, abuses would take place. For example, many opponents falsely claim the poor or elderly might be covertly pressured to choose physician-assisted dying over more complex and expensive palliative care options. Oregon’s law went into effect in 1997 and Washington’s in 2009, and throughout the laws’ history, there has never been a documented case of coercion or undue influence related to the Death with Dignity Act. Not one.

WHAT ARE THE ARGUMENTS IN FAVOR?

Those who argue Death with Dignity Acts are ethically justifiable offer the following arguments:

Respect for autonomy: Decisions about time and circumstances around death are very personal. Every competent person should have right to choose death.

Justice: Justice requires that we “treat like cases alike.” Competent, terminally ill patients are allowed to hasten death by treatment refusal. For some patients, treatment refusal will lead to more suffering. Justice requires that we should allow assisted death for these patients.

Compassion: Suffering means more than pain; there are other physical and psychological burdens. It is not always possible to relieve suffering. Allowing terminally ill people to determine the timing and manner of their deaths is a compassionate response to unbearable suffering.

Individual liberty vs. state interest: Though society has strong interest in preserving life, that interest lessens when person is terminally ill and has strong desire to end life. A complete prohibition on assisted death excessively limits personal liberty.

Openness of discussion: Assisted death already occurs, albeit in secret. For example, morphine drips ostensibly used for pain relief may be a covert form of assisted death or euthanasia. In states without Death with Dignity laws, open discussions between patients and physicians are avoided and prohibited. Legalization would promote open discussion.

WHAT DOES THE MEDICAL PROFESSION THINK OF ASSISTED DEATH?

A 2014 Medscape survey found that 54% of medical doctors favor physician-assisted dying, up from 46% in 2010. We also know that many physicians who support the end-of-life option are reluctant to declare so publicly for fear of repercussions in their workplace or medical community.

The American Medical Association opposes aid-in-dying laws. However, not only does the AMA represent a declining number of physicians (only about 1 in 3 doctors are AMA members), a 2011 survey of physicians conducted by Jackson & Coker found that 77% of physicians believe the AMA no longer reflects their views. In 2015, the California chapter of the AMA changed its position on physician-assisted dying from opposed to neutral, stating that they “believe it is up to the individual physician and their patient to decide voluntarily whether the End of Life Option Act is something in which they want to engage.”

A number of medical associations have endorsed physician-assisted dying, including the American Public Health Association, the American College of Legal Medicine, the American Medical Women’s Association, the American Medical Student Association, and the Denver Medical Society.

For my patients who have used this law, I was honored that I could be with them every step of the way, ensuring that they were cared for, and that they had control of the final days of their lives. That’s what death with dignity really means.

—NICHOLAS GIDEONSE, MD

WHAT DO PATIENTS AND THE GENERAL PUBLIC THINK OF PHYSICIAN-ASSISTED DEATH?

Surveys of patients and members of the general public find that the vast majority think that PAS is ethically justifiable in certain cases, most often those cases involving unrelenting suffering.

IF I AM A DOCTOR, WHAT SHOULD I DO IF A PATIENT ASKS ME FOR ASSISTANCE IN DYING?

One of the most important aspects of responding to a request for assisted dying is to be respectful and caring. Virtually every request represents a profound event for the patient, who may have agonized over his situation and the possible ways out. The patient’s request should be explored, to better understand its origin, and to determine if there are other interventions that may help ameliorate the motive for the request. In particular, one should address:

motive and degree of suffering: are there physical or emotional symptoms that can be treated?

psychosocial support: does the patient have a system of psychosocial support, and has she discussed the plan with them? accuracy of prognosis: every consideration should be given to acquiring a second opinion to verify the diagnosis and prognosis.

degree of patient understanding: the patient must understand the disease state and expected course of the disease. This is critical since patient may misunderstand clinical information. For instance, it is common for patients to confuse “incurable” cancer with “terminal” cancer.

WHAT IF THE PATIENT PERSISTS?

If a patient’s request for assistance in dying persists, each individual clinician must decide his or her own position and choose a course of action that is ethically justifiable. Careful reflection ahead of time can prepare one to openly discuss your position with the patient, acknowledging and respecting difference of opinion when it occurs. Organizations exist which can provide counseling and guidance for terminally ill patients. No physician, however, should feel forced to supply assistance if he or she is morally opposed to assisted death.

Additional Resources

* Note: Listing of the resources in this section does not constitute our endorsement thereof. We make no warranties and cannot vouch for content developed by individuals or organizations not affiliated with California Death with Dignity, Death with Dignity National Center, or Death with Dignity Political Fund.